Management of Hepatitis C Virus Genotype 4 Treatment Failure: A Real-World Single Center Experience

Background: Treatment failure with direct-acting antiviral (DAA) therapy is associated with worsening of liver disease especially in cirrhotic patients. Moreover, data on retreatment of HCV genotype 4 patients (G4) with DAA failure are still very limited, since they are under- represented in most clinical trials.

Aims: To evaluate the efficacy of retreatment of Egyptian HCV G4 DAA failure patients based on the use of a new DAA class from currently available first- generation DAA regimens other than the patient had relapsed to.

Methods: 29 Egyptian HCV G4 DAA failure patients were retreated by switch to a new DAA class from first- generation DAA regimens than the patient had relapsed to independent of RAS testing. 25 out of these 29 patients completed retreatment and 4 patients were lost for follow–up.

Results: Among other risk factors, by logistic regression analysis, only older age, high CTP score and high base-line viral load were independent predictors of DAA failure among our cohort. Also SOF/RBV regimen was the most common prior DAA regimen associated with treatment failure (48.3%).

All our DAA failure patients were cirrhotics that made prompt retreatment of them a rescue strategy to halt viral replication and disease progression.

After retreatment, 22 (88%) of the 25 patients who completed retreatment achieved SVR12 and the remaining 3 (12%) failed.

These 3 patients completed a second retreatment, one achieved SVR and the other 2 relapsed again (re-relapsers)

Conclusion: The overall SVR rate (88%) demonstrated in this real –world study, clearly shows that, the retreatment policy of DAA failure patients by switch to – or addition of a new drug class independent of RAS testing is a good retreatment option, that may be of importance for many areas of the world with no or difficult access to RAS testing or second-generation rescue regimens.